Pulse rate and chest compressions

[JNASTY]

If a patient has a slow pulse rate and is breathing and conscious would u start compressions? ( pulse is 40 bpm) I know CPR says they they need to be pulse less but I was doing some training and was told that if a Pt has a pulse of 50 bpm or less to start compressions. Now I'm a little confused, should this only be done on an unconscious Pt?

Can anyone clarify this at all for me a little bit? Thanks

 

[NomadicMedic]

Now, stop and read what you wrote. A person who's BREATHING and CONSCIOUS. Does that person need CPR?
What are the indications for CPR?

They may (stress on MAY) eventually need CPR, but conscious with a HR of 50 can be normal, or if the patient is "sick", may require pharmacological or electrical intervention.

A marathon runner or a patient on beta blockade might always have a HR in the 50s and be perfectly happy.

 

[chaz90]

Perhaps you're thinking of infants? Compressions and ventilations are indicated in infants when their HR is <60. This is profoundly bradycardic for that patient population and considered to have a low enough cardiac output to need intervention.

 

[JNASTY]

I understand if the Pt is conscious then CPR is not needed, but let's say the Pt is UNconsciouse HR is 50 bpm and starts to fall to 40 bpm, and Resp are 12 would you want to start compressions for the Pt? let's say you were called to the scene by his wife because he was not feeling well, he was conscious when you fist arrived but is getting worse.

Maybe what I'm asking is, is there a min HR that you would want to start compressions for someone who's condition is getting worse?

 

[captinfocker]

TREAT THE PT NOT THE NUMBERS, my hr is 40-50 sitting here typing this and if you started compressions on me well it might not end well for you.

as for your question, if they are getting worse that quickly I would have called for als if available and or started transporting to the closest hospital. So no there isn't a magic number. My rule of thumb unless they are unconscious and pulse-less they don't get compressions.

 

[STXmedic]

Please do not fall into the "Treat the patient, not the monitor" crap. We have tools for a reason. If they were so useless, we wouldn't have them. Look at the entire picture, not just one or the other.

OP, DE and Chaz answered your question. Newborns get compressions below 60bpm, typically refractory to oxygen. Adults get compressions when their heart is not pumping. If it's pumping, albeit it slowly, they do not get compressions. If you're BLS, either get ALS en route or load and go if you have a symptomatic, bradycardic patient.

 

[chaz90]

I understand if the Pt is conscious then CPR is not needed, but let's say the Pt is UNconsciouse HR is 50 bpm and starts to fall to 40 bpm, and Resp are 12 would you want to start compressions for the Pt? let's say you were called to the scene by his wife because he was not feeling well, he was conscious when you fist arrived but is getting worse.

Maybe what I'm asking is, is there a min HR that you would want to start compressions for someone who's condition is getting worse?

No.

There is precisely one HR that needs compressions in the adult population. 0.

I can't stress this enough, and it's one of the most basic and fundamental concepts in medicine. Pulseless people who are only merely dead and not yet profoundly so get chest compressions, and those who have any kind of detectable pulse at the carotid artery do not. If your patient's pulse rate is 30 with a BP of 50 systolic, you still don't do compressions. As discussed, best have ALS coming and/or be moving at a rapid (yet safe) rate to the nearest ED at that point. If the patient becomes pulseless (clearly a big risk at that point) start CPR.

If you only read one word of my reply, let it be the first one of my post. Clear enough?

 

[JNASTY]

I understand the answer that you gave ,Chaz, the reason I asked the question is I was practicing Pt assessments with a Paramedic and I'm only an EMT, he gave me the scenario and the Pt HR was falling but I didn't start CPR because there still was a pulse. After I completed the assessment he came back to me and said I should have started compressions if the hr was falling that low. This is why I asked to get others opinion. Maybe it's just a Paramedic thing they do?

 

[DesertMedic66]

I understand the answer that you gave ,Chaz, the reason I asked the question is I was practicing Pt assessments with a Paramedic and I'm only an EMT, he gave me the scenario and the Pt HR was falling but I didn't start CPR because there still was a pulse. After I completed the assessment he came back to me and said I should have started compressions if the hr was falling that low. This is why I asked to get others opinion. Maybe it's just a Paramedic thing they do?

Negative. Paramedics can administer medications and/or pace the patient to get the HR up. Compressions on adults are only for a HR of 0 (excluding PEA).

 

[STXmedic]

If that's exactly what he said and there was no misunderstanding, your paramedic needs to go back to school.

 

[chaz90]

Compressions on adults are only for a HR of 0 (excluding PEA).

I wouldn't even add the PEA caveat here since we're going off of palpable pulse rather than electrical HR. That's obviously why HR of ~200 doesn't matter for pulseless V-Tach either.

This isn't directed at you either Desert, as I know exactly what you meant. More adding clarification for the OP.

 

[chaz90]

I understand the answer that you gave ,Chaz, the reason I asked the question is I was practicing Pt assessments with a Paramedic and I'm only an EMT, he gave me the scenario and the Pt HR was falling but I didn't start CPR because there still was a pulse. After I completed the assessment he came back to me and said I should have started compressions if the hr was falling that low. This is why I asked to get others opinion. Maybe it's just a Paramedic thing they do?

Said paramedic was mistaken if you understood him correctly. There's no special paramedic or even doctor magic that makes them able to do compressions on a patient with a pulse.

 

[DesertMedic66]

I wouldn't even add the PEA caveat here since we're going off of palpable pulse rather than electrical HR. That's obviously why HR of ~200 doesn't matter for pulseless V-Tach either.

This isn't directed at you either Desert, as I know exactly what you meant. More adding clarification for the OP.

I was lazy and didn't want to specify palpable pulse or electrical HR lol

 

[Christopher]

I understand the answer that you gave ,Chaz, the reason I asked the question is I was practicing Pt assessments with a Paramedic and I'm only an EMT, he gave me the scenario and the Pt HR was falling but I didn't start CPR because there still was a pulse. After I completed the assessment he came back to me and said I should have started compressions if the hr was falling that low. This is why I asked to get others opinion. Maybe it's just a Paramedic thing they do?

Paramedics are an odd bunch, I'll give you that. But no, if you can still palpate a pulse their intrinsic cardiac output is better than your CPR.

(I've always been dubious about pediatric CPR due to HR below 60 and why we wouldn't supplement the HR through more effective means...but that's a question for another day.)

 

[Medic Tim]

Only time I can think of where I would do compressions with a pulse ( on an adult) is post rosc . We continues compressions for 2 minutes..... Unless they ask is to stop.

 

[mycrofft]

disregard.

 

[mycrofft]

Only time I can think of where I would do compressions with a pulse ( on an adult) is post rosc . We continues compressions for 2 minutes..... Unless they ask is to stop.

Bet that asking thing is about, uh, 100%

 

[Medic Tim]

I have had a few witnessed arrests where we did a defib and no CPR and they were right back talking to us. I have had others where we worked them a few rounds and got pulses back but they remained unconscious. They didn't complain.

 

[mycrofft]

I have had a few witnessed arrests where we did a defib and no CPR and they were right back talking to us. I have had others where we worked them a few rounds and got pulses back but they remained unconscious. They didn't complain.

HA I bet. We had a guy in Lincoln who would say "Here I go" and go unconscious with no palpable pulse. Actually saw it at the ER once. Doc said "Stand by", and about one minute later the guy was back. NO idea what that was about, but bystanders had called 911 a few times on him.

 

[Akulahawk]

Basically, if an adult is conscious and alert... there's no need to do CPR on them. Their cardiac output (while possibly in the drain) is high enough to keep the brain going for now. Someone who is unconscious but still has a pulse may not have sufficient cardiac output to do that... but if you can feel a pulse, that patient's cardiac output is still likely to be higher than you doing chest compressions.

As a Paramedic, if my patient has such a low HR that they're unconscious/non-responsive, there are things I can do about that. As an EMT, I'm going to do one of two things: find a way to get ALS to the patient very quickly or get the patient to ALS very quickly. In the meantime, I'm going to at least provide some oxygen, ensure as open an airway as I can mange, and ventilate if necessary.